Diagnostic Performance of QFR for the Evaluation of Intermediate Coronary Artery Stenosis Confirmed by Fractional Flow Reserve

Abstract

Introduction Quantitative flow ratio (QFR) is a novel method enabling efficient computation of FFR from three-dimensional quantitative coronary angiography (3D QCA) and thrombolysis in myocardial infarction (TIMI) frame counting. We decided to perform a systematic review and quantitative meta-analysis of the literature to determine the correlation between the diagnosis of functionally significant stenosis obtained by QFR versus FFR and to determine the diagnostic accuracy of QFR for intermediate coronary artery stenosis. Methods We searched PubMed, Embase, and Web of Science for studies concerning the diagnostic performance of QFR. Our meta-analysis was performed using the DerSimonian and Laird random effects model to determine sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). The sROC was used to determine diagnostic test accuracy. Results Nine studies consisting of 1175 vessels in 1047 patients were included in our study. The pooled sensitivity, specificity, LR+, LR-, and DOR for QFR were 0.89 (95% CI: 0.86-0.92), 0.88 (95% CI: 0.86-0.91), 6.86 (95% CI,: 5.22-9.02), 0.14 (95% CI: 0.10-0.21), and 53.05 (95% CI: 29.75-94.58), respectively. The area under the summary receiver operating characteristic (sROC) curve for QFR was 0.94. Conclusion QFR is a simple, useful, and noninvasive modality for diagnosis of functional significance of intermediate coronary artery stenosis.

Quantitative Flow Ratio or Angiography for the Assessment of Non-culprit Lesions in Acute Coronary Syndromes: Protocol of the Randomized Trial QUOMODO

“…This strategy reflects the typical procedures used in daily routine; all lesions believed to be significant at angiography will be treated in one staged session. In patients randomized to QFR-guided revascularization, all lesions (one or more per vessel) associated with a vessel QFR <0.80 and a residual QFR >0.80 will be treated in one staged session ( 13 ). The treatment plan will be scheduled (according to angiography or QFR) by study investigators not involved in patient care.…”

“…A number of studies have now shown that the results of QFR correlate well with those of FFR, and a recent meta-analysis of nine studies for a total of 1,175 vessels in 1,047 patients reported a pooled sensitivity, specificity, positive and negative likelihood ratio for QFR of 0.89 (95% CI: 0.86–0.92), 0.88 (95% CI: 0.86–0.91), 6.86 (95% CI,: 5.22–9.02), 0.14 (95% CI: 0.10–0.21). The area under the summary receiver operating characteristic (sROC) curve for QFR was 0.94 ( 13 ). Further, QFR has been validated by several studies in the context of non-culprit lesions of ACS ( 14 – 18 ).…”

Systemic analysis of diagnostic performance and agreement between fractional flow reserve and quantitative flow ratio

“…All examined articles complied with ethical standards. 12 Three meta-analyses where the QFR was analyzed had been detected in PubMed research. The fi rst meta-analyses comprised nine studies which included 1175 blood vessels' results.…”